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Sexual and Reproductive Health Education Interventions Conducted across the League of Arab States: A Regional Scoping Review
No full textPurpose of Review: Women and men in the League of Arab States (LAS) face significant barriers in accessing comprehensive sexual and reproductive health (SRH) information due to cultural taboos, gender inequality, and structural limitations within health and education systems. Despite increasing global recognition of the importance of SRH education, interventions in the LAS remain fragmented and under-evaluated. This scoping review aims to identify, describe, and appraise existing interventions addressing SRH education-related outcomes across LAS countries, with a focus on assessing their effectiveness, limitations, and areas for future research and policy development. Recent Findings: Fourteen studies met inclusion criteria, representing diverse interventions including school-based, community-led, peer-supported, mHealth, and clinical-provider-based approaches. While many interventions demonstrated improvements in SRH knowledge and attitudes, significant barriers such as provider stigma, lack of parental and community support, and gender-based restrictions persist. Gaps remain in addressing the needs of marginalized populations, including refugees and LGBTQ + youth, and few studies report long-term behavioral outcomes. Summary: Effective SRH education interventions in the LAS require culturally sensitive, inclusive, and sustainable models integrated within health and education systems. Future research and policy should prioritize long-term evaluations and target underserved populations to ensure equitable access to SRH education and services
Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform.
Get PDFBACKGROUND: COVID-19 severe enough to require hospitalisation is commonly associated with acute kidney injury. However, it remains unclear whether COVID-19 leads to long-term kidney outcomes in the broader population. METHODS: We undertook a population-based, matched cohort study. With the approval of NHS England, we used primary and secondary care electronic health records from England using the OpenSAFELY-TPP platform. We compared people with and without COVID-19 using fully-adjusted, stratified, cause-specific Cox models for kidney failure, 50% reduction in kidney function, and death. FINDINGS: Overall, all outcomes were increased after COVID-19 over the course of follow-up (HR for kidney failure 1.93 [95% CI 1.84-2.03]). Hazards of kidney failure were greatest after hospitalisation (HR 7.74 [95% CI 7.00-8.56]) and remained increased beyond 180 days of follow-up. There was no evidence of increased risk in those not hospitalised (HR 0.85 [95% CI 0.79-0.90]). Increased kidney failure was more pronounced in black ethnicity (HR 4.50 [95% CI 2.92-6.92]) compared to white ethnicity (HR 1.82 [95% CI 1.71-1.94]). Amongst those hospitalised with COVID-19, there was no attenuation of kidney failure between the first wave (HR 8.74 [95% CI 6.88-11.08]) and the Omicron wave (HR 8.36 [95% CI 6.81-10.27]). INTERPRETATION: We observed increased long-term kidney outcomes in people hospitalised with COVID-19, as well as notable ethnic differences. Our results suggest strategies to minimise severe COVID-19 should continue to be optimised among vulnerable groups, and that kidney function should be proactively monitored after hospital discharge. FUNDING: National Institute for Health and Care Research
Can mixed-methods help us better understand congestion on Low Traffic Neighbourhood boundary roads?
Get PDFLow Traffic Neighbourhoods (LTNs) aim to improve conditions for walking, wheeling and cycling by restricting motor vehicle movements on residential streets while maintaining access to all addresses. Despite generally positive evidence, LTNs faced backlash, often linked to concerns that motor traffic from inside LTNs is displaced onto surrounding ‘boundary roads’. In this paper, we bring together large-scale sensor data and spatially-transcribed interview data from a case-study LTN to discuss how mixed methods analysis can help to ease the LTN controversy by revealing the multiple ways in which the ‘problem’ of congestion is understood. By integrating quantitative evidence of changes in congestion associated with LTN implementation with residents' perceptions and experiences of the same scheme, we discuss how and why these diverge, revealing the complexity of capturing what congestion is. We argue that concerns about congestion are influenced not only by changes in traffic volumes, but also by how these changes are framed in public discourse. We consider dissonances between what ‘counts’ for residents and what is counted in quantitative data, and how what is (in)visible to residents affects their perceptions of congestion. We also highlight the limitations of each method and the importance of integrating multiple forms of evidence. The paper helps nuancing perspectives on congestion and its role in LTN debates, while also providing guidance on mixed methods approaches to evaluating transport policies. We recommend that these should combine attention to localised impacts with a broader evaluation framework that reflects the long-term public health and climate goals of LTNs
Comparative performance of the InBios SCoV-2 Detect TM IgG ELISA and the in-house KWTRP ELISA in detecting SARS-CoV-2 spike IgG antibodies in Kenyan populations.
Get PDFBACKGROUND: The InBios SCoV-2 Detect™ IgG ELISA (InBios) and the in-house KWTRP ELISA (KWTRP) have both been used in the estimation of SARS-CoV-2 seroprevalence in Kenya. Whereas the latter has been validated extensively using local samples, the former has not. Such validation is important for informing the comparability of data across the sites and populations where seroprevalence has been reported. METHODS: We compared the assays directly using pre-pandemic serum/plasma collected in 2018 from 454 blood donors and 173 malaria cross-sectional survey participants, designated gold standard negatives. As gold standard SARS-CoV-2 positive samples: we assayed serum/plasma from 159 SARS-CoV-2 PCR-positive patients and 166 vaccination-confirmed participants. RESULTS: The overall agreement on correctly classified samples was >0.87 for both assays. The overall specificity was 0.89 (95% CI, 0.87-0.91) for InBios and 0.99 (95% CI, 0.97-0.99) for KWTRP among the gold standard negative samples while the overall sensitivity was 0.97 (95% CI, 0.94-0.98) and 0.93 (95% CI, 0.90- 0.95) for InBios and KWTRP ELISAs respectively, among the gold standard positive samples. In all, the positive predictive value for InBios was 0.83 (95% CI, 0.79-0.87) and 0.98 (95% CI, 0.96-0.99) for KWTRP while the negative predictive value was 0.98 (95% CI, 0.97- 0.99) and 0.97 (95% CI, 0.95-0.98) for InBios and KWTRP respectively. CONCLUSIONS: Overall, both assays showed sufficient sensitivity and specificity to estimate SARS-CoV-2 antibodies in different populations in Kenya
Performance of Cross-Validated Targeted Maximum Likelihood Estimation.
Get PDFBACKGROUND: Advanced methods for causal inference, such as targeted maximum likelihood estimation (TMLE), require specific convergence rates and the Donsker class condition for valid statistical estimation and inference. In situations where there is no differentiability due to data sparsity or near-positivity violations, the Donsker class condition is violated. In such instances, the bias of the targeted estimand is inflated, and its variance is anti-conservative, leading to poor coverage. Cross-validation of the TMLE algorithm (CVTMLE) is a straightforward, yet effective way to ensure efficiency, especially in settings where the Donsker class condition is violated, such as random or near-positivity violations. We aim to investigate the performance of CVTMLE compared to TMLE in various settings. METHODS: We utilized the data-generating mechanism described in Leger et al. (2022) to run a Monte Carlo experiment under different Donsker class violations. Then, we evaluated the respective statistical performances of TMLE and CVTMLE with different super learner libraries, with and without regression tree methods. RESULTS: We found that CVTMLE vastly improves confidence interval coverage without adversely affecting bias, particularly in settings with small sample sizes and near-positivity violations. Furthermore, incorporating regression trees using standard TMLE with ensemble super learner-based initial estimates increases bias and reduces variance, leading to invalid statistical inference. CONCLUSIONS: We show through simulations that CVTMLE is much less sensitive to the choice of the super learner library and thereby provides better estimation and inference in cases where the super learner library uses more flexible candidates and is prone to overfitting
Optimization and Characterization of N-Acetamide Indoles as Antimalarials That Target PfATP4.
Get PDFTo discover new antimalarials, a screen of the Janssen Jumpstarter library against Plasmodium falciparum uncovered the N-acetamide indole hit class. The structure-activity relationship of this chemotype was defined and culminated in the optimized frontrunner analog WJM664, which exhibited potent asexual stage activity and high metabolic stability. Resistant selection and whole-genome sequencing revealed mutations in PfATP4, which was validated as the target by showing that analogs exhibited reduced potency against parasites with resistance-conferring mutations in PfATP4, a metabolomic signature similar to that of the PfATP4 inhibitor KAE609, and inhibition of Na+-dependent ATPase activity consistent with on-target inhibition of PfATP4. WJM664 inhibited gamete development and blocked parasite transmission to mosquitoes but exhibited low efficacy in aPlasmodium berghei mouse model, which was attributed to ATP4 species differentiation and its moderate systemic exposure. Optimization of these attributes is required for N-acetamide indoles to be pursued for development as a curative and transmission-blocking therapy
Valganciclovir for cytomegalovirus viraemia in advanced HIV disease: a phase 2b randomized placebo-controlled trial of valganciclovir for cytomegalovirus viraemia in adults and adolescents with advanced HIV disease.
No full textMortality among adults hospitalized with advanced HIV disease (AHD; CD4 20%; there is an urgent need to evaluate strategies to reduce mortality within this extremely high-risk group. Approximately 50% of adults with CD4 counts 500 IU ml-1 from two hospitals in Uganda and South Africa. Participants will be randomized 1 : 1 to either valganciclovir 900 mg orally or matched placebo for 28 days. Safety monitoring and CMV viral load testing will occur weekly until week 4, and thereafter at week 8 and at study termination at week 12. The primary endpoint is a composite of adverse events of special interest, re-hospitalization or death within 8 weeks. Secondary endpoints include median reduction in CMV viral load at day 28 and week 12, proportion with CMV below the limit of detection at weeks 2, 4, 8 and 12, mortality, grade ≥3 adverse events and serious adverse events, duration of hospitalization, tolerability, HIV treatment response, proportion with ganciclovir resistance and valganciclovir pharmacokinetics. Data from the NIRVANA phase 2 trial including valganciclovir pharmacokinetic data will be used to inform design of a multi-site phase 3 randomized controlled trial powered for survival to investigate whether valganciclovir reduces mortality among hospitalized adults with AHD-associated CMV viraemia.This article is part of the discussion meeting issue 'The indirect effects of cytomegalovirus infection: mechanisms and consequences'
Integrating Sustainable Agricultural Practices to Enhance Climate Resilience and Food Security in Sub-Saharan Africa: A Multidisciplinary Perspective
Get PDFSub-Saharan Africa (SSA) is experiencing escalating climate variability, land degradation, and food insecurity, which threaten livelihoods and economic stability. Sustainable agricultural practices (SAPs), including climate-smart agriculture, conservation agriculture, and agroecology, offer promising strategies to boost productivity while enhancing ecological stability. This review proposes that multidisciplinary integration of SAPs, encompassing agronomy, socioeconomics, and governance, is the most promising route to achieving climate-resilient food systems in SSA by 2030. Despite its proven benefits, the use of SAPs remains limited. This is largely because of financial constraints, weak institutional frameworks, and inadequate infrastructure. To address these challenges, this review evaluates the role of SAPs in mitigating climate risk, improving soil health, and enhancing food security. It also identifies systemic adoption barriers and examines the effectiveness of policy and financing frameworks. Drawing on evidence from across SSA, including Ethiopia’s agroforestry success and Senegal’s millet resilience, this review highlights how integrating sustainable practices with postharvest innovation and community-driven approaches can strengthen food systems. Ultimately, the findings underscore that weaving science, policy, and grassroots action is essential for building a resilient and food-secure SSA, particularly within the context of the 2025 global adaptation agenda
Modelling international spread of clade IIb mpox on the Asian continent.
Get PDFOBJECTIVE: To understand and simulate international spread of the disease mpox, considering variations in sexual activity levels and international travel among men who have sex with men. METHODS: We developed a mathematical model that considers differing sexual networks and the volume of international travel among men who have sex with men, calibrated to disease incidence data in Japan. We then used our model to simulate the potential international spread of mpox across 42 countries and territories on the Asian continent, assuming Japan as the origin of spread. FINDINGS: Our simulations identified countries and territories at a high risk of mpox introduction, many being low- and middle-income countries and territories in the Western Pacific and South-East Asia regions. We found that the simulated risk of importation gradually shifted over time from the Western Pacific to the South-East Asia region, and later to the Eastern Mediterranean and European regions. This simulated pattern broadly aligns with actual mpox spread patterns observed between 2023 and 2024. CONCLUSION: Our multicountry model for mpox outbreaks can help project the possible trajectory of mpox spread across countries and territories on the Asian continent. Our findings warrant global efforts to contain mpox outbreaks, particularly support for low- and middle-income countries and territories which are at higher risk of introduction, so that the risk of continued spread across the Asian continent and beyond is reduced
Associations between postpartum haemorrhage, postnatal mental health and longer term mental illness: a record-linked cohort study.
Get PDFAIM: To investigate the associations between primary postpartum haemorrhage (PPH), postnatal mental health and longer-term mental illness in a high-income setting. METHODS: A population-based retrospective cohort study of 18,798 women giving birth between 2008 and 2016 in Grampian, Scotland, was conducted, using linked data from the Aberdeen Maternity and Neonatal Databank and Scottish administrative healthcare datasets. 'Longer-term mental illness' was assessed using a composite outcome comprising mental-health related hospitalisation, prescription or death, from the end of the first postnatal year to 10 years after birth. We used extended Cox regression models to investigate the association between primary PPH in any first or subsequent births (the exposure) and subsequent mental illness, adjusted for sociodemographic, past medical history and pregnancy and birth-related factors, stratified by the presence of mental illness in the first postnatal year. RESULTS: We found no association between PPH and longer-term mental illness beyond the first postnatal year, regardless of severity of PPH or mode of birth [adjusted hazard ratio (aHR) 0.97, 95% confidence interval (CI) 0.81-1.16, p = 0.75]. Women who received psychotropic medication, or were hospitalised for mental illness in the first postnatal year, were around 12 times more likely [aHR 12.77,95% CI 10.94-14.91,p < 0.001] to experience mental illness in the second and third postnatal year, with a continuing association for up to 10 years after the first postnatal year, independent of PPH status. CONCLUSIONS: This study provides no evidence of an association between PPH and longer-term mental illness, after taking into account the presence of mental illness in the first postnatal year